Creating Smiles

At
St. Jude, plastic surgeons help children regain their quality of life through new techniques ranging from migraine relief to facial reanimation.

At age 7, a brain tumor nearly stole Alexandra “Alex” Dedinsky’s sight. As a teen, it robbed her of a normal life, crushing her with migraines so severe and of such duration as to keep her homebound. Alex was desperate for relief when a plastic surgeon from St. Jude Children’s Research Hospital used an unusual surgical technique to short-circuit the pain. The result left Alex pain free for the first time in years.

St. Jude has expanded its services in plastic surgery, particularly for children who have nerve damage caused by brain tumors or their treatment. For many patients — such as children with facial paralysis — the service literally gives them a reason to smile.

“We see patients every week and help with the wound care clinic as well,” explains Robert Wallace, MD, chief of plastic surgery at St. Jude. “It’s unusual for a cancer hospital to offer services as comprehensive as these.”

Seeking solace

About 11 years ago, Alex’s parents, both physicians, noticed a problem with her eyesight. In the backyard one day, her dad administered an impromptu eye test, which indicated that Alex had no vision in her left eye and partial vision in the right.

“It had always been that way, and I thought that was the way everybody saw. I didn’t know any differently,” Alex says.

An MRI revealed a tumor pressing on her optic nerve. Tests revealed juvenile pilocytic astrocytoma, a slow-growing tumor of the brain or spinal cord.

A quick survey of the couple’s medical colleagues pointed the family to St. Jude. After treatment with radiation therapy, Alex’s vision returned, although she does have some lingering problems with her eyesight.

For years, chemotherapy kept the tumor at bay but left Alex coping with headaches.

“I have had headaches since I was little,” Alex says. “But, about a year ago, I started getting severe migraines. Nothing helped. For a five-month period, I couldn’t do anything. I couldn’t go to school. I couldn’t read. I couldn’t sleep. It really changed my life.”

Putting quality into life

After exhausting several treatment options, Alex’s St. Jude neurologist, Zsila Sadighi, MD, consulted Wallace. Swelling in Alex’s facial muscles and tissues was constricting the nerves in that region, causing chronic migraines. The clinicians used the drug Botox® to relax those muscles, offering temporary relief.

When Alex responded favorably to that treatment, Wallace suspected that she might have an even more dramatic and permanent response with a surgical approach.

He and his associate, Petros Konofaos, MD, devised a plan.

It’s unusual for a cancer hospital to offer services as comprehensive as these.

- Robert Wallace, MD

“We incorporated one of the cosmetic techniques we use to do brow lifting, but instead of lifting the brow, we decompressed the nerves in that region. It’s a new technique. This was the first time it was ever done in Memphis and certainly the first time ever at St. Jude,” Wallace says.

Alex has been migraine-free since that operation.

“I got my life back. I was able to get back to school. I was able to sleep and eat,” she says. This fall, she will enroll in college, where she plans to study art, design and architecture.

“St. Jude has been about quality of life,” says Alex’s mom, Patti. “They don’t just say, ‘The tumor is smaller, go home.’ They say, ‘You are not living life the way you need to. How can we make it better? What can we do to have you personally, emotionally and socially recover from the disease?’”

Dazzling possibilities

Plastic surgery services are improving quality of life for other St. Jude patients, as well.

“We do a lot of things that people would not necessarily think about as being plastic surgery,” Wallace says.

His team helps children who need reconstruction after limb-salvage procedures. Plastic surgeons are also involved in the treatment of head and neck cancers and in nerve reconstruction.

One service offered by St. Jude plastic surgeons is facial reanimation, which addresses the facial paralysis that can occur after brain tumor treatment.

Other facilities offer operations that may help with a smile, but those procedures do not generally produce a smile that is coordinated with the non-paralyzed portion of the face. Wallace and Konofaos use layered techniques to produce a coordinated smile.

“We’re very excited about this program because most of these children have one goal: To have a coordinated smile,” Wallace says. “And the only way they can have that is if they have this kind of surgery.”